DENVER — She wants to live, more than anything. But if her brain tumor returns, Megan Igel wants the freedom to end her life.

A state ballot measure here in Colorado could give her a measure of control: It would allow physicians to prescribe a lethal dose of medication to terminally ill adults who request aid in dying.

Supporters have raised more than $5 million and a September poll found 70 percent of voters back the measure, which would make Colorado the sixth state to allow assisted suicide. (The Washington, D.C., City Council is expected to approve a similar measure later this month.)

The Catholic Church and other religious groups are fighting back, arguing that it’s “illogical” to for the state to allow some patients to hasten their deaths, even as taxpayers are funding a public health battle against suicide in Colorado.

The measure has also drawn fire from disability rights advocates — among them, Carrie Ann Lucas, who has lived for years with a progressive neuromuscular disease that has left her reliant on a wheelchair, a ventilator, and a gastronomy tube.

“We should be legislating to protect the most vulnerable people in our population, not putting them at further risk,” Lucas said.

Megan Igel never expected she’d be in the thick of this controversy — a vote with the power to shape both her work and her life.

A geriatric physician’s assistant, Igel has watched seniors ready to die linger on in hospice care, often for weeks, until at last their bodies shut down.

“I wouldn’t want that,” she’s thought many times, abstractly.

Then, a year ago, after worsening headaches, Igel was diagnosed with a brain tumor. Surgery has bought her time. But it’s an incurable cancer that will recur. Doctors just can’t say when.

Just before the diagnosis, Igel had helped care for a 25-year-old woman with the same type of brain tumor, an astrocytoma. The patient couldn’t talk or walk after surgery. “I told another physician assistant friend, ‘Don’t let me be like [her], wanting to die, trapped in my body, with no quality of life,’” Iger said.

That hasn’t happened: Igel, who is 41, recovered well from brain surgery, though she has to pace herself and is often exhausted at the end of the day. She’s cut back on work and started meditating. She prays, and tries to achieve a sense of balance in her life.

“I wanted my diagnosis to make me a better person, and to learn lessons from it,” she said, sitting in the kitchen of her airy home in a Denver suburb.

As Igel talked about the future, her eyes teared and her golden retriever came over to nuzzle her. She wants to be brave. But she doesn’t know what lies ahead.

Ending her life is the last thing Igel wants to do. She has two young daughters she adores, a loving husband, a large circle of friends, and even plans for retirement.

“I want to live as fully as I can for as long as I can,” Igel said, “but if I get to a point where I don’t have any quality of life and current medications aren’t keeping me comfortable, after consulting with my family and the people I love, I would consider it.”

Igel has the same type of tumor as Brittany Maynard, an eloquent 29-year-old with terminal cancer who made national headlines when she began speaking out in favor of the right to “death with dignity” in 2014. Later that year, Maynard swallowed a fatal dose of medication.

Support for assisted suicide swelled.

“After Brittany there was a sea change — a big national conversation,” said Toni Broaddus, acting director of political affairs for Compassion & Choices, a Denver organization advocating for aid-in-dying measures across the country.

California voted last year to allow assisted suicide; the new provisions took effect in June. Oregon, Washington, and Vermont have similar laws, and Montana’s Supreme Court has ruled that the practice is legal in that state.

Colorado’s bill closely tracks the groundbreaking “death with dignity” law passed in Oregon in 1994. It applies to mentally competent adults told by two physicians that they have six months or less to live. Before someone can get a lethal prescription, he or she must make two voluntary verbal requests, 15 days apart, and submit a written request signed by two witnesses.

Doctors must refer patients to a psychologist or psychiatrist if they suspect depression or other types of mental illness or cognitive impairment. Every case must be reported to state authorities. And coercion is punishable as a felony.

Still, opponents say there aren’t enough safeguards to prevent abuse. The Denver Post, the state’s largest newspaper, came out in opposition to Proposition 106, calling it problematic and poorly crafted.

The evangelical group Focus on the Family, headquartered in Colorado Springs, also opposes the measure, arguing that patients may be pushed into suicides to save money. “Doctor-assisted suicide is cheaper than treatment, and that’s dangerous in a profit-driven health care system,” Carrie Gordon Earll, the group’s vice president of public policy, said in a statement.

Pressure from insurers, health care providers, and family members can be subtle but insidious, said Lucas, who founded Disabled Parent Rights, which provides legal services to parents and children with disabilities.

“As disabled people, all the time we get the message that your life isn’t worth living,” she said.

In Colorado’s physician community, there is deep division. The Colorado Medical Society surveyed its members in February; 56 percent favored “physician-assisted suicide” while 35 percent were opposed. The margin was tighter among doctors who frequently treat patients with terminal illnesses: 50 percent in favor, 41 percent opposed.

The group voted to remain neutral on Proposition 106, but medical societies in Denver, Boulder, and Pueblo chose to endorse the measure.

That alarms Dr. Alan Rastrelli, medical director of a Catholic hospice in Denver. “We physicians aren’t doing our job if people are suffering at the end of life. We should embrace the means to relieve suffering, not kill the sufferer,” he said.

Palliative care and hospice care are the answer, not assisted suicide, Rastrelli said. Yet these services are not widely available outside metropolitan areas in Colorado, research indicates.

On the other side of the divide, Dr. David Hibbard of Boulder, who’s board certified in hospice and palliative care, takes professional and personal comfort from the prospect of aid-in-dying.

“While a vast majority of patients would benefit from hospice, there are a minority whose suffering can’t be well-addressed,” he said. Sometimes this suffering is physical; sometimes it’s emotional or existential. Addressing this misery is part of his obligation to patients, Hibbard said.

Hibbard has a personal stake in the debate, too: Diagnosed with Parkinson’s disease 10 years ago, he uses a cane to walk and can no longer type or write independently. Should the time come when he can’t feed himself, dress himself, use the toilet, or get out of bed, he said he would consider aid-in-dying.

“It’s an option I would like to have available,” Hibbard said. “I might not use it, but I would certainly be comforted knowing it was available to me.”

This article is reproduced with permission from STAT. It was first published on Nov. 4, 2016. Find the original story here.

Left:
Aaron and Megan Igel, at home in a suburb of Denver. Photo by Judith Graham/STAT